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Re: Treatment for eclampsiaFrom: Len2976@aol.comWed Jan 21 06:08:30 2004
The other night while I was in L&D with a labor patient, EMS brought in a patient who was visiting relatives and had been receiving prenatal care in a nearby area. Another OB practice was on "walk-in" call, so I was mostly an observer. There were no prenatal records available (of course) and the main complaints of the patient and her husband were a mild uterine contractions, a persistant headache, and lethargy over the past day. The patient also seemed to have some confusion and "fogginess" over how she had been feeling over the past 2-3 hrs. B/Ps were 154/104 and 148/95, DTRs were +3.. Initial FHT tracing show very minimal BTBV. Labor was not well established--contractions were mild and the cervix was 1 cm. dilated. The on-call physician was called--further observation and labs were ordered. (The nurses wanted to start Mg SO4 and were concerned about the FHR tracing--he wanted to wait till labs were back--but that is another matter.) I was in the observation room evaluating another patient of mine when I heard the husband call out and the bed rails shake. I went to give assistance while waiting for staff to arrive in the room.. The usual initial seizure steps were taken--airway, position, protection. After the seizure oxygen was administered, the physician was notified, and an emergency C/S planned. Initial FHR bradycardia was followed by absent BTBV and late decelerations. The obstetrician ordered MgSO4 4 gm bolus (over 30 minutes) and the anesthesiologist (who was there) gave 10 mg of Valium IV push. The usual 2 gm per hour of MgSO4 was to follow. My question: I was always taught that the treatment for eclampsia was MgSO4--1 gm per minute--IV push--up to 5 gms. Is there another more preferred treatment? Lenora McCall, CNM
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